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Nutrition

Chemo Nutrition

Podcast

The Nutrition Protocol — Audio Version

This page covers a lot of ground. If you'd rather listen than read, I had an audio version produced covering the full nutrition protocol — the cycle timing, the supplement cautions, the clinical reasoning behind the changes. About 11 minutes.



This calendar shows which foods I emphasize and which I avoid at different points in my FOLFIRI + bevacizumab cycle. The cycle is 14 days (Day 0 = infusion day, Day 13 = day before next infusion). The carousel auto-advances to today's cycle day. The recipe page covers how to actually make these foods — with protein counts so you can stack toward the 120–130 g/day target.


Daily Amounts Quick Reference
  • Protein target: 120–130 g/day — see recipe combinations
  • Berries: 1–2 cups
  • Garlic: 1–2 cloves (cooked)
  • Onion: ½–1 medium (cooked)
  • Mushrooms: 1 cup (cooked)
  • Salmon: 120–150 g
  • Hydration: 2–2.5 L/day minimum
  • Broccoli: 1 cup (cooked)
  • Broccoli sprouts: 1–2 tbsp (Days 8–11)
  • Fat ceiling (Days 0–5): 40–50 g/day
⚠️ Curcumin + Irinotecan Interaction — Read First

Curcumin is a known inhibitor of UGT1A1 (UDP-glucuronosyltransferase 1A1) and CYP3A4. Irinotecan's active toxic metabolite SN-38 is inactivated by UGT1A1. Inhibiting this enzyme increases SN-38 exposure, which amplifies irinotecan's dose-limiting toxicities: late-onset diarrhea and neutropenia.

Curcumin at supplement doses (≥500 mg) should not be taken during active FOLFIRI cycles without oncologist approval. If cleared, restrict to Days 7–12 only, at ≤500 mg, not within 48 hours of infusion. Culinary turmeric in cooking is acceptable throughout the cycle.

Note: Sertraline (a moderate CYP3A4 inhibitor) stacks with curcumin to compound this interaction. Discuss both supplements with your oncologist.



Eating Rules During Chemotherapy

Food / Category Primary Benefit Secondary Benefit Best Days Notes
Cruciferous vegetables Cancer inhibition Liver detox, chemo support Days 5–13 (best 8–11) Cooked early; stronger types (sprouts, Brussels) Days 8–11 only
Garlic Cancer inhibition Immune support Days 5–13 Cooked preferred; chop/crush, rest 5 min before cooking
Onions Cancer inhibition Immune support Days 5–13 Sautéed or roasted preferred
Mushrooms (shiitake, maitake — food) Chemo support Immune support Days 3–13 Fully cooked; easier to tolerate than capsules early in cycle
Berries Healthy cell protection Inflammation reduction Days 1–13 Low GI; 1–2 cups/day; blueberries, raspberries, strawberries
Green tea (EGCG) Cancer inhibition Anti-angiogenic support Days 5–13 Avoid Days 0–4; contains caffeine — limit to 1–2 cups
Turmeric (culinary) Inflammation reduction Cancer inhibition Days 0–13 (all days) Culinary turmeric in cooking is safe throughout; supplement dose requires oncologist clearance
Curcumin supplement (≥500 mg) ⚠️ See drug interaction warning Requires oncologist approval Days 7–11 only (if cleared) UGT1A1 inhibitor — compounds irinotecan toxicity. Do not use without oncologist approval.
Ginger (culinary) Nausea relief Gut support / inflammation Days 0–13 (all days) Safe throughout cycle; weak ginger tea good on nausea days
Omega-3 foods (salmon, walnuts) Muscle preservation Inflammation reduction Days 5–10 Food-source only — no fish oil supplements with bevacizumab
Mushroom capsules (Turkey Tail, Reishi) Immune support Inflammation reduction Days 5–11 Hold Days 0–4 and Day 12–13; 1–3 g extract/day
Vitamin D (supplement) Chemo support Immune modulation Days 0–13 (all days) Target 40–60 ng/mL; 2,000–4,000 IU/day; take with fat-containing meal
Selenium (Brazil nut or supplement) Hashimoto's antibody reduction Antioxidant support Days 0–13 (all days) 1–2 Brazil nuts/day (≈100–200 mcg); do not exceed 2 nuts
Alpha-lipoic acid (ALA) Neuropathy management Antioxidant Days 2–13 Hold Days 0–1 (infusion + pump); 600 mg/day for neuropathy
Probiotics (Lactobacillus rhamnosus GG) Diarrhea severity reduction Gut microbiome support Days 6–11 Discuss with oncologist; not during Days 0–5 (mucosal barrier compromised)
Bone broth (low-fat, skimmed) Gut recovery Hydration support Days 0–6 Skim rendered fat before consuming — gallstone/amylase protocol
Coffee (black, 1–2 cups) Liver support NAFLD risk reduction Days 4–13 Multiple studies associate coffee with lower NAFLD and liver fibrosis rates; hold Days 0–3

Supplement Timing

HOLD = do not take. All supplement decisions must be reviewed with your oncologist.

Supplement Day 0 Days 1–2 Days 3–4 Days 5–6 Days 7–11 Days 12–13
Curcumin (if oncologist-cleared) HOLD HOLD HOLD HOLD ✓ (Days 7–11, ≤500 mg) HOLD
Alpha-lipoic acid (ALA) HOLD Day 2 ✓ ✓ ✓ ✓ ✓
Turkey Tail / Reishi (capsules) HOLD HOLD HOLD Day 5 ✓ ✓ HOLD
Vitamin D ✓ ✓ ✓ ✓ ✓ ✓
Selenium (Brazil nut or supplement) ✓ ✓ ✓ ✓ ✓ ✓
Glucosamine / chondroitin ✓ ✓ ✓ ✓ ✓ ✓
Collagen / protein powder ✓ ✓ ✓ ✓ ✓ ✓
Probiotics (LGG strain) HOLD HOLD HOLD Day 6 ✓ ✓ HOLD
Ginger (culinary) ✓ ✓ ✓ ✓ ✓ ✓
Fish oil supplements: NOT RECOMMENDED with bevacizumab — use food-source omega-3 only (salmon, walnuts).

Why These Foods Matter

Protein — 120–130 g/day

At ~87 kg under active FOLFIRI, protein requirements are 1.2–1.5 g/kg/day to prevent lean mass loss and support albumin synthesis. Albumin drops to 3.6–3.8 g/dL under active treatment — adequate protein intake is the primary dietary lever to prevent further decline. Albumin ≥4.0 g/dL is a HIPEC candidacy threshold. See the recipe page for per-serving protein counts and day-by-day combination examples.

Hydration — 2–2.5 L/day minimum

Bevacizumab (anti-VEGF) increases arterial and venous thromboembolic risk. Dehydration concentrates blood and compounds this risk.

  • Days 0–5: Prioritize hydration even when nausea suppresses appetite. Water, weak ginger tea, diluted electrolyte drinks, bone broth.
  • Days 6–13: At least 2 L/day; more in hot weather or if exercising.
  • Limit caffeine and alcohol — both are dehydrating and irritating to a compromised GI tract.
  • Electrolyte note: Potassium runs upper-normal to mildly elevated in labs. Avoid potassium supplementation. Limit concentrated sources: large banana portions, avocado in excess, high-potassium bone broth.
Managing Irinotecan Late Diarrhea — Days 1–5

Irinotecan causes two types of diarrhea: early (cholinergic, within 24 hours, managed by atropine) and late (Days 2–5+, from SN-38 toxicity to the intestinal mucosa). Late diarrhea is the primary dietary concern.

What to eat (Days 0–5)
  • Soluble fiber is protective: oats, psyllium husk, ripe banana, applesauce, cooked potato (no skin). Soluble fiber absorbs water and slows intestinal transit.
  • White rice, plain toast, plain crackers — low residue, easy to tolerate. Chicken congee is built around this principle.
  • Diluted electrolyte drinks or oral rehydration solution to replace losses.
What to avoid (Days 0–5)
  • Insoluble fiber: raw vegetables, cruciferous vegetables, nuts, seeds, skins — avoid entirely until Day 5 minimum.
  • High-fat foods: rendered fat in broth, full-fat dairy, fried foods — fat stimulates cholecystokinin and increases gut motility.
  • Caffeine, alcohol, spicy foods, citrus juice.
  • Sugar alcohols (sorbitol, mannitol found in sugar-free products) — osmotic effect worsens diarrhea.
Probiotic consideration
RCT evidence (Osterlund et al., 2007, Annals of Oncology) supports Lactobacillus rhamnosus GG for reducing irinotecan-associated diarrhea severity. Introduce Days 6–13 only — not during Days 0–5 when mucosal barrier is compromised. Greek yogurt with live cultures is the food-source equivalent. Discuss with oncologist before starting capsule probiotics.

Omega-3
  • reduces post-chemo inflammation
  • helps preserve muscle during recovery
  • best on Days 5–10
  • ~1,500 mg EPA/DHA per day from food sources
  • salmon (120–150 g) — primary source, ~34 g protein per fillet
  • walnuts (small handful) — secondary source
  • Fish oil supplements are not recommended with bevacizumab — use food-source omega-3 only
Berries
  • healthy cell protection
  • reduces post-chemo inflammation
  • easy on digestion across the full cycle
  • daily dose: 1–2 cups per day
  • best choices: blueberries, raspberries, strawberries (fresh or frozen)
  • Add to Greek yogurt bowl from Day 5 onward

Garlic
  • cancer inhibition support
  • immune support
  • daily dose: 1–2 cloves per day
  • best prep: chop/crush, rest 5–10 minutes, then cook lightly or add at the end
  • chemo timing: best Days 5–13; avoid raw on GI-sensitive days
  • Built into chicken congee (Day 5+), lentil soup, and poached chicken poaching liquid
Onions
  • cancer inhibition support
  • immune support
  • daily dose: ½–1 medium onion per day
  • best prep: cooked (sautéed / roasted) for tolerance
  • chemo timing: best Days 5–13; split across meals if needed

Turmeric / Curcumin
  • cancer inhibition support (culinary dose)
  • inflammation reduction
  • culinary turmeric: ½–1 tsp in cooking — safe throughout the cycle. Built into the red lentil soup at a meaningful dose.
  • supplement dose (≥500 mg): requires oncologist clearance — see drug interaction warning at top of page
  • if cleared: Days 7–11 only, ≤500 mg, with black pepper (piperine) or fat; not within 48 hours of infusion
Mushrooms
  • chemo support
  • immune support
  • daily dose (food): 1–2 cups cooked per day (shiitake, maitake)
  • best prep: fully cooked; sautéed or added to soups. Shiitake works well in chicken congee from Day 6.
  • capsules (Turkey Tail / Reishi): 1–3 g extract per day; Days 5–11 only — hold on infusion/pump days and Days 12–13

Cruciferous Vegetables

Cancer & Chemo Benefits
Cruciferous vegetables contain compounds (sulforaphane and indoles) that:
  • support liver detox pathways
  • suppress cancer growth signaling
  • reduce inflammation
  • protect healthy cells during recovery
  • are protective against gastric intestinal metaplasia progression — keep these in the plan
This is especially relevant for colorectal cancer with liver involvement.

Best chemo days to eat
  • Days 8–11: full benefit window
  • Days 5–7: moderate portions, fully cooked
Avoid Days 0–4 when GI is fragile and irinotecan diarrhea risk is active.


Most beneficial (ranked in order)
Potency matters, but tolerance matters more during chemo. On GI-sensitive days, prioritize cauliflower, bok choy, and cooked cabbage; save sprouts, broccoli, and Brussels for better days.
  • Broccoli sprouts (most potent): 1–2 tbsp per day (Days 8–11 only).
  • Broccoli: 1 cup per day cooked (lightly steamed/sautéed).
  • Brussels sprouts: ½–1 cup per day cooked (Days 8–11 only).
  • Kale: 1–2 cups per day cooked (or 1 cup raw on good GI days).
  • Red cabbage: 1–2 cups per day cooked.
  • Cauliflower: 1–2 cups per day cooked — well tolerated from Day 3.
  • Bok choy: 1–2 cups per day cooked.
How to prepare
  • Chop first, rest 5–10 minutes
  • Steam lightly or sauté gently
  • Avoid boiling or high heat — destroys active compounds

Vitamin D — Target 40–60 ng/mL

Last documented level: 31.2 ng/mL (June 2020) — suboptimal. No subsequent measurement available. For active colorectal cancer, evidence from the VITAL trial and multiple observational cohorts associates serum 25-OH-D levels below 40 ng/mL with worse outcomes.

  • Get a current 25-OH-D level if not done recently.
  • Typical supplementation to reach target: 2,000–4,000 IU/day cholecalciferol (D3), adjusted based on labs.
  • Take with a fat-containing meal for absorption — baked salmon provides enough fat to ensure absorption.
  • Recheck every 3–6 months.
Selenium — 100–200 mcg/day

Anti-thyroglobulin antibody (anti-TG) is markedly elevated (539.7 UI/mL, normal <100), confirming active Hashimoto's autoimmunity in the remaining thyroid lobe. Selenium at 100–200 mcg/day has consistent evidence for reducing TPO and anti-TG antibodies in Hashimoto's thyroiditis.

  • Practical source: 1–2 Brazil nuts per day provide approximately 100–200 mcg selenium. Do not exceed 2 nuts/day — excess selenium is toxic.
  • Alternative: 200 mcg selenomethionine supplement.
  • Avoid iodine-excess foods: kelp, seaweed supplements, large amounts of iodised salt.
  • Safe to take throughout the cycle (Days 0–13).

Permanent Dietary Exclusions

These restrictions apply every day — not just during the active chemo window. They address structural comorbidities: gallstones, elevated pancreatic amylase, erosive esophagitis Grade B, and antral gastric intestinal metaplasia.

Gallstones + Elevated Pancreatic Amylase

High-fat meals trigger cholecystokinin release, which stimulates gallbladder contraction (biliary colic risk) and pancreatic secretion (pancreatitis risk).

  • Daily fat ceiling: 40–50 g on Days 0–5; up to 60–70 g on Days 6–13 from clean sources.
  • Use low-fat or skimmed bone broth on Days 0–5 — skim rendered fat before consuming.
  • Avoid: fried foods, full-fat dairy, large nut servings, high-fat red meat.
  • Preferred fat sources: olive oil (1–2 tbsp/day), salmon (120–150 g), avocado (½ per serving maximum), walnuts (small handful).
  • Fish oil supplements on top of food-dose omega-3 are not recommended.
Erosive Esophagitis Grade B

Diagnosed May 2025. Requires dietary consideration throughout the cycle, not just during pump days.

  • Avoid acidic foods: citrus fruits and juice, tomato products, vinegar-based dressings.
  • Avoid spicy foods and peppermint (relaxes the lower esophageal sphincter).
  • Do not eat within 2–3 hours of lying down; elevate head of bed.
  • Eat 5–6 small meals rather than 3 large ones.
  • If not already prescribed, discuss proton pump inhibitor (PPI) therapy with your gastroenterologist — Grade B erosion warrants pharmacological management.
Gastric Intestinal Metaplasia — Cancer Precursor Management

Complete-type antral intestinal metaplasia (diagnosed May 2025, involving ~10% of glands) is a recognised gastric cancer precursor. Dietary risk factors for progression must be permanently excluded:

  • High-sodium foods: Processed foods, canned soups, soy sauce in large amounts, cured products. Target <2,000 mg sodium/day.
  • Cured and processed meats: Bacon, ham, salami, deli meats, hot dogs — nitrates and N-nitroso compounds are direct mucosal carcinogens. This is why the turkey meatball recipe uses fresh ground turkey breast, not cured or processed meat.
  • Smoked foods: Smoked fish, smoked meats — polycyclic aromatic hydrocarbons.
  • H. pylori status is negative (confirmed IHC) — one protective factor.
  • Cruciferous vegetables and garlic already in this plan are protective against metaplasia progression. Keep them.
Blood Glucose Management — HbA1c 6.0% (Pre-Diabetic Range)

HbA1c 6.0% as of April 2024 — not rechecked since. Cancer cells exploit glucose via aerobic glycolysis; hyperglycaemia may promote tumour proliferation. Dexamethasone pre-medication causes acute glucose spikes.

  • Days 4–13: Replace white rice, pasta, and white bread with lentils, chickpeas, quinoa, oats, sweet potato.
  • Avoid fruit juice, sweetened drinks, and concentrated dried fruit.
  • Structure meals as protein + vegetables + controlled complex carbohydrate.
  • Days 0–3: White rice and plain starchy foods are acceptable — chicken congee uses white rice intentionally for this window; gut tolerance takes priority during the irinotecan-sensitive window.
  • Action: Request HbA1c with next blood draw. Target ≤5.7% through dietary management.

Liver Support — Persistent Elevated Transaminases

AST, ALT, GGT, and ALP have been persistently elevated since 2022, predating chemotherapy. Combined with long-standing hyperlipidemia, borderline HbA1c, and no recent lipid panel, non-alcoholic fatty liver disease (NAFLD) is a plausible co-contributor alongside chemo-related hepatotoxicity.

  • Reduce fructose: no fruit juice, no high-fructose corn syrup products; whole fruit in moderation (1–2 pieces/day).
  • Reduce refined carbohydrates outside the therapeutic Days 0–3 window.
  • Coffee (1–2 cups/day, black): multiple studies associate coffee with lower rates of NAFLD and liver fibrosis. Acceptable Days 4–13 if tolerated.
  • Avoid alcohol entirely during active treatment.
  • Cruciferous vegetables (Days 5–13) are protective for liver detoxification pathways — already in the plan.

Pre-HIPEC Nutritional Preparation

If CRS+HIPEC proceeds after completion of FOLFIRI + bevacizumab cycles, nutritional status is a major determinant of surgical outcomes, wound healing, and recovery.

  • Bevacizumab hold: Must be discontinued 6–8 weeks before surgery for wound healing — anti-VEGF impairs angiogenesis and tissue repair. Coordinate with oncology team.
  • Albumin target: ≥4.0 g/dL at time of surgery. Current level under active treatment: 3.6–3.8 g/dL. Begin high-protein dietary push at least 4–6 weeks before planned surgery — poached chicken breast (40 g/serving) and whey isolate shakes are the primary tools for this push.
  • Pre-operative carbohydrate loading (ERAS protocol): Standard enhanced recovery protocols recommend a 50 g oral carbohydrate drink the evening before surgery and again 2–3 hours before anaesthesia (where fasting protocol permits). Discuss with surgical team.
Micronutrient optimisation before surgery
  • Vitamin D: Reach target range (40–60 ng/mL) before surgery date.
  • Iron stores: Ferritin >50 ng/mL — increase haem iron sources if low (lean red meat, lentils, fortified cereals + vitamin C).
  • Zinc: Adequate intake from whole grains, legumes, pumpkin seeds — supports wound healing.
  • Vitamin C: 200–500 mg/day from food or supplement — collagen synthesis for wound repair.

Labs to Monitor

Align with oncology cycle bloodwork where possible.

Test Frequency Target / Action
Albumin Every cycle ≥4.0 g/dL (HIPEC candidacy threshold); below 3.5 g/dL = increase protein intake urgently — prioritise whey shakes and poached chicken
25-OH Vitamin D Every 3–6 months Target 40–60 ng/mL; adjust D3 supplementation based on result
Ferritin + Serum Iron Every 3 months Ferritin >50 ng/mL; if low, increase haem iron sources
HbA1c Every 3 months Target ≤5.7%; shift Day 4–13 carbs to lentils, oats, sweet potato if rising — last tested April 2024
Lipid panel (TC, LDL, HDL, TG) Every 6 months Not tested since 2022; last LDL 161 mg/dL — overdue
CRP Every cycle Track trend; persistent elevation (2.2–3.1 mg/dL) indicates insufficient anti-inflammatory dietary effect
Pancreatic amylase Every cycle Trend guide for fat restriction; elevated trend = tighten fat ceiling, review broth skimming protocol
Potassium Every cycle Upper-normal trend; avoid excess dietary potassium and all potassium supplements

Important: This is personal research documentation, not medical advice. All supplement decisions, dietary modifications, and lab targets must be validated with your treating oncology team.